Saturnino Luz

Multidisciplinary Medical Team Meetings: An Analysis of Collaborative Working with Special Attention to Timing and Teleconferencing

In this paper we describe the process of a multi-disciplinary medical team meeting (MDTM), its functions and operation in colocated and teleconference discussions. Our goal is to identify the elements and mechanics of operation that enhance or threaten the dependability of the MDTM as a “system” and propose technologies and measures to make this system more reliable. In particular, we assess the effect of adding teleconferencing to the MDTM, and identify strengths and vulnerabilities introduced into the system by the addition of teleconferencing technology. We show that, with respect to the system’s external task environment, rhythms of execution of pre-meeting and post-meeting activities are critical for MDTM success and that the extension of the MDTM to wider geographic locations with teleconferencing might disrupt such rhythms thereby posing potential threats to dependability. On the other hand, an analysis of vocalisation patterns demonstrates that despite difficulties related to coordination and awareness in video-mediated communication (evidenced by increased time spent in case discussion, longer turns, decreased turn frequency and near lack of informal exchanges) the overall case discussion structure is unaffected by the addition of teleconferencing technology into proceedings.

Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments

BackgroundThe development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.MethodsFor one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed.ResultsThe number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging) can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted.ConclusionDifficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working.

Achieving Diagnosis by Consensus

This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

Meeting browsing

Meeting, to discuss and share information, take decisions and allocate tasks, is a central aspect of human activity. Computer mediated communication offers enhanced possibilities for synchronous collaboration by allowing seamless capture of meetings, thus relieving participants from time-consuming documentation tasks. However, in order for meeting systems to be truly effective, they must allow users to efficiently navigate and retrieve information of interest from recorded meetings. In this article, we review the state of the art in multimedia segmentation, indexing and browsing techniques and show how existing meeting browser systems build on these techniques and integrate various modalities to meet their users’ information needs.

Shared decision making needs a communication record

Increasing dependability in collaboration work among health professionals will directly improve patient outcomes, and reduce healthcare costs. Our research examines the development of a shared visual display to facilitate data entry and validation of an electronic record during multidisciplinary team meeting discussion, where specialists discuss patient symptoms, test results, and image findings. The problem of generating an electronic record for patient files that will serve as a record of collaboration, communication and a guide for later tasks is addressed through use of the shared visual display. Shortcomings in user-informed designed, structured data-entry screens became evident when in actual use. Time constraints prompt the synopsis of discussion in acronyms, free text, abbreviations, and the use of inferences. We demonstrate how common ground, team cohesiveness and the use of a shared visual display can improve dependability, but these factors can also provide a false sense of security and increase vulnerability in the patient management system.

Dimensionality reduction for active learning with nearest neighbour classifier in text categorisation problems

Dimensionality reduction techniques are commonly used in text categorisation problems to improve training and classification efficiency as well as to avoid overfitting. The best performing dimensionality reduction techniques for text categorisation are supervised, hence utilise the label information of the training data. Active learning is used to reduce the number of labelled training examples for problems where obtaining label information is expensive. Since the vast majority of data supplied to active learning are unlabelled, supervised dimensionality reduction techniques cannot be readily employed. For this reason, active learning in text categorisation problems do not perform dimensionality reduction thereby restricting the choice of classifier. In this paper we investigate unsupervised dimensionality reduction techniques in active learning for text categorisation problems. Two unsupervised techniques are investigated, namely document frequency and principal components analysis. We empirically show increased performance of active learning, using a k-nearest neighbour classifier, when dimensionality reduction is applied using the unsupervised techniques.

Translation practice in the workplace: contextual analysis and implications for machine translation

This paper reports the results of a qualitative study which investigated localisation activities performed by translators working in two Language Service Providers. It argues that maintaining the appropriate quality level in this setting is a collaborative task which involves several translators. This perspective entails taking a broader view of the translation process than usually found in the Machine Translation (MT) literature and detailing the various knowledge sources which are deployed in this collaborative effort. The impact of collaboration on trust is examined, and a comparison is made between the relatively seamless flow of work between translators and the more strained relationships with remote contributors. In support of this view, the paper contrasts the flexibility of the analysed work practices with the rigid ways which tend to be followed when introducing MT into this setting. We identify the need to support collaboration and communication more actively as a broader issue in translation settings. While current strategies for introducing MT tend to further isolate translators from remote contributors, we propose that MT can serve as the catalyst for establishing a more dynamic and collaborative relationship between them.

The nonverbal structure of patient case discussions in multidisciplinary medical team meetings

Meeting analysis has a long theoretical tradition in social psychology, with established practical ramifications in computer science, especially in computer supported cooperative work. More recently, a good deal of research has focused on the issues of indexing and browsing multimedia records of meetings. Most research in this area, however, is still based on data collected in laboratories, under somewhat artificial conditions. This article presents an analysis of the discourse structure and spontaneous interactions at real-life multidisciplinary medical team meetings held as part of the work routine in a major hospital. It is hypothesized that the conversational structure of these meetings, as indicated by sequencing and duration of vocalizations, enables segmentation into individual patient case discussions. The task of segmenting audio-visual records of multidisciplinary medical team meetings is described as a topic segmentation task, and a method for automatic segmentation is proposed. An empirical evaluation based on hand labelled data is presented, which determines the optimal length of vocalization sequences for segmentation, and establishes the competitiveness of the method with approaches based on more complex knowledge sources. The effectiveness of Bayesian classification as a segmentation method, and its applicability to meeting segmentation in other domains are discussed.

Automatic identification of experts and performance prediction in the multimodal math data corpus through analysis of speech interaction

An analysis of multiparty interaction in the problem solving sessions of the Multimodal Math Data Corpus is presented. The analysis focuses on non-verbal cues extracted from the audio tracks. Algorithms for expert identification and performance prediction (correctness of solution) are implemented based on patterns of speech activity among session participants. Both of these categorisation algorithms employ an underlying graph-based representation of dialogues for each individual problem solving activities. The proposed Bayesian approach to expert prediction proved quite effective, reaching accuracy levels of over 92\% with as few as 6 dialogues of training data. Performance prediction was not quite as effective. Although the simple graph-matching strategy employed for predicting incorrect solutions improved considerably over a Monte Carlo simulated baseline (F1 score increased by a factor of 2.3), there is still much room for improvement in this task.

WebWOZ: a wizard of oz prototyping framework

Language Technology (LT) based applications become more popular as technology improves. Prototyping early in the design process is critical for the development of high quality applications. It is difficult, however, to do low-fidelity prototyping (e.g. paper prototyping) of applications based on LT. One technique that has been used for this kind of prototyping is Wizard of Oz (WOZ). However, this generally involves the development of one-off user and wizard interfaces. A tool that facilitates the flexible integration of LT components into WOZ experiments is desirable. In this paper we explore the requirements for such a tool, drawing from the literature and a first WOZ experiment in which different wizards were observed and their behaviour was analysed.